摘要:

Although stressful life events (SLEs) play a major role in many etiologic theories of major depression (MD), important questions remain about the nature of their association with the onset of depressive episodes. We assessed over the last year, in female twins ascertained from a population based registry, the occurrence of 15 classes of SLEs and the onset of DSM-III-R MD and 2-week generalized anxiety disorder (GAD). The sample contained 24,648 person-months, 316 onsets of MD, and 239 onsets of GAD. SLEs were rated on long-term contextual threat and dependence. Discrete time-survival analyses were employed. The association between SLEs and depressive onsets was usually strongest in the month of occurrence but extended for "difficulty-like" events for up to 6 months. The depressogenic effect of SLEs was strongly predicted by contextual threat level, although some low threat events significantly increased risk for MD. The risk for a depressive onset given the number of reported SLEs within one month was: no event, 0.9%; one, 3.4%; two, 6.8%; and three, 23.8%. Although a few events were relatively specifically depressogenic or anxiogenic, most SLEs increased risk for both MD and GAD. The risk period produced by SLEs range from short-lived to relatively prolonged. High threat events encompass most but not all of the depressogenic effects of SLEs. Multiple SLEs in the same month substantially increase the risk for a depressive onset. The specificity of most SLEs for depressive versus anxiety syndromes is modest.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A physiological hyperarousal state, which can be reactivated by traumatic stimuli, occurs frequently in patients with posttraumatic stress disorder (PTSD). The goals of this study were to determine whether physiological hyperarousal measured by increased heart rate is a specific response to reminders of a patient's own traumatic events or a more generalized hyperarousal state. Five brief videotape scenes of traumatic events (hurricane, auto accident, Cambodian refugee camp, domestic violence, and Vietnam War) were shown to two patient groups with PTSD (Vietnam veterans and Cambodian refugees) and three control groups (Vietnam veterans, Cambodian refugees, and non-patient Americans). Observations of subjects' behavior, subjective ratings of distress, and heart rate change were recorded and evaluated. The results indicated that Cambodians with PTSD had the most reactions as measured by behavior and heart rate changes. These tended to occur during all scenes, not just the specific Cambodian scene, indicating a general nonspecific arousal. The Vietnam veterans had the fewest changes implying an inhibition of response. The control groups were intermediate in physiological response. The response in PTSD patients to reactivation scenes is complex and probably relates to type and degree of trauma, as well as to culture.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Vietnamese are one of the fastest growing ethnic minority groups in the United States. The purpose of this study was to determine the prevalence and correlates of high depression scores among Vietnamese men in three locales. Computer assisted telephone interviews were conducted with adult Vietnamese men in San Francisco/Alameda Counties, Santa Clara County, and the city of Houston. Telephone numbers of households with Vietnamese surnames were chosen randomly from area telephone books. Depression was assessed using a previously validated Vietnamese language depression screening instrument with 86% sensitivity and 96% specificity for major depression. Between 8.2% and 9.8% of the men scored above the cut-off. Logistic regression analysis revealed that men who were the least proficient in English, poorer, unemployed or disabled, veterans, and those living in Houston were more likely to have a high depression score. Based on the characteristics of the screening instrument, rates of clinical depression among Vietnamese men may be modestly higher than rates for men in the general population. However, high-risk subgroups identified by our analyses may suffer from substantially higher rates of clinical depression. To our knowledge, ours is the first study to show that community context or locale is an independent predictor of high depressive symptoms in this population. These findings have important implications for prevention and intervention approaches to depression among Vietnamese men.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study tested the hypothesis that dually diagnosed adolescent substance abusers could be matched to effective treatments on the basis of their comorbid psychopathology. Specifically, patients with externalizing disorders would have better outcomes when treated with cognitive-behavioral group treatment (CBT), and subjects with internalizing disorders without comorbid externalizing disorders would fare better in interactional group treatment (IT). Thirty-two dually diagnosed adolescent substance abusers were randomized into two 12-week manual guided outpatient group psychotherapies: CBT and IT. At 3-month follow-up, no patient-treatment matching effects were identified. Adolescents assigned to CBT demonstrated a significant reduction in severity of substance use compared with those assigned to IT. Improvement in severity of family function showed a trend in favor of CBT. School function, peer-social relationships, legal problems, and psychiatric severity all showed a consistent nonsignificant direction in favor of CBT over IT. CBT appears to be a promising short-term psychosocial intervention for adolescents.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study attempted to identify the necessary and sufficient change factors in short-term anxiety-provoking psychotherapy (STAPP). Twenty patients were randomly assigned to either STAPP or a form of nondirective therapy almost devoid of psychodynamic elements but with common factors of psychotherapy intact. Both treatments were 20 sessions long, were manualized, and therapists in both conditions were experienced clinicians receiving manual-guided supervision. Most patients had a diagnosis of anxiety. Results showed that patients in both treatments improved greatly symptomatically and that no further gains were made after termination. Treatments were equally effective. The therapeutic alliance was a strong predictor of symptom improvement. The findings underscore the importance of common factors pertaining to the therapeutic relationship, and they may open to question, to some degree, the therapeutic effectiveness of psychodynamic technique factors in STAPP. The way in which specific and common factors can be brought together under the umbrella of the concept of affect attunement is discussed.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Many patients with psychotic disorders lack awareness of being ill. This often presents a serious impediment to treatment compliance. We hypothesized that exposing partially remitted patients to videotapes of themselves, made while they were acutely psychotic, might increase their insight into the nature of their illness. Eighteen acutely psychotic inpatients were assigned randomly to a control or experimental group and interviewed on videotape 24 to 48 hours after admission, using scales that measure insight (Insight and Treatment Attitudes Questionnaire [ITAQ]) and psychopathology (Brief Psychiatric Rating Scale [BPRS]). One to six weeks later, when judged to be significantly improved, subjects were shown either a videotape of their initial interview (experimental group) or a placebo videotape (control group) and then reinterviewed 24 to 48 hours later on videotape, using the BPRS and ITAQ scales. Evaluation of initial and final ITAQ and BPRS scores revealed significantly greater improvement in insight scores and in delusionality in the experimental group. However, no significant difference in overall psychopathology was seen for the two groups. These results suggest that exposure of hospitalized patients to videotapes of their own psychotic behavior may be a cost-effective therapeutic tool for developing personal insight into psychotic illness.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Given the association of injury and posttraumatic stress disorder (PTSD), we examined whether head injury might be associated with increased frequency and severity of PTSD. Using a mail survey, we queried 143 male combat veterans with and without PTSD, who had previously participated in PTSD research in our laboratory, about their history of head injury. Respondents with a PTSD diagnosis were significantly more likely to report a history of head injury than those without. Patients with a history of head injury also reported more severe symptoms of PTSD compared with PTSD patients without head injury. The association of head injury and PTSD was not due to greater combat exposure in the head-injured group. Head injury is associated with a greater likelihood of developing combat-related PTSD and with more severe PTSD symptoms. This retrospective study did not address mechanisms that could account for this finding. The results indicate head injury should be systematically assessed by both nonpsychiatric and psychiatric physicians concerned with the psychological sequelae of exposure to victimizing experiences.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Current descriptors of personality disorder (PD) are an amalgam of two constructs, personality style and/or disorder. We seek to determine whether their intrinsic personality style descriptors are proxy measures of, or independent of, disordered personality functioning. In a sample of depressed patients, psychiatrists rated 16 differing PD personality style vignettes and assessed eight differing manifestations of disordered functioning. When "personality" vignettes and identified personality clusters were intercorrelated with "disorder" variables, interdependence was generally evident, suggesting that the personality descriptors underpinning current definition of the PDs actually act as proxy criteria for assessing disorder because they are, in and of themselves, descriptors of pathological functioning. The obsessional personality vignette provided an exception, seeming to be independent of disordered function. Such results assist consideration of how best to model, define and measure the personality disorders.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The authors have gathered and analyzed the visual hallucinations described in the mid- to late-19th century from archived medical records of the former psychiatric hospital "Osservanza" in Imola, northern Italy. Though the investigation was not intended as a statistical survey, the principal aim being to classify the hallucinations according to their outward characteristics, the authors have tried to locate the possible sources of these phenomena in folklore and religious iconography.

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1998

数据来源: OVID